Future for Billers and Coders?

Future for Billers and Coders?

During a conversation between my office manager and physican I was told that because electronic medical records becoming mandatory, the role of the medical coder and biller would be eliminated. That basically by the time the physican leaves the exam room and push send on his pc the visit would be electronically coded and sent directly to the insurance companies. So there would be no need for a medical coder and biller. Just wondering if anyone has any insight on this.

Is the doctor gonna follow up to make sure his own claims are paid too? Actually submitting the claim is the easy part of our job...even when presented with clean claims the insurance companies do their best to avoid paying...

There are companies out there that only submit the claim, sure, they will probably have problems. If you are one of the good ones, who actually make sure that the full cycle is completed, I don't see it as that bad...actually a good thing, might allow me to focus on the followup.

I guess the goal is paperless, but as Christina mentioned filing the claim is the easy part. Coding is more difficult, then follow up, re-determinations etc... Much more to consider when people who do this work are taken out of the equation. I wouldn't worry about what we do becoming obsolete.

Do you think they will know what modifier to put with what CPT claim to get it past the appropriate edits, etc. My doctor doesn't have a clue how to send electronic claims, nor how to deal with NPI, billing issues, claims followup, denials, etc.

Yeah, my provider has an EMR, for 5 years now, and he doesn't even use the electronic charge tickets...they take too much of his time and he can't go from patient to patient. He does chart as he goes, which is nice. He still does the old fashioned way...write all the codes down an put in my basket at the end of each day.

I currently own my own billing company and have wondered about this for a little while now. It does seem that technology is ready to take over everything. HOWEVER:

1) EMR software is extremely expensive (and sucks billing wise--there are 2 I know about and the software is atrocious from a billing standpoint). Not many doctors are going to go for an investment like this and mess with the "status quo".

2) As someone mentioned here, claims still need to be scrubbed and sent to the right places. Modifiers and dx linkage still has to get done as well as follow up.

3) Payments have to get posted as well as deductibles. Medicare non crossovers have to get sent out and patients have to get bills for what is their responsibility. When patients get their bills and call to question them, who's going to explain..the doctor? Also... not every carrier is hooked up to receive claims electronically.

4) There are endless changes within electronic formats of how claims are received never mind the other nuances of staying abreast with the updating of the current software.

5) Doctors still need and want their reports. In some EMR softwares there are literally a hundred different reports to pick in which 80 of them are useless. Good luck going through the reports you want because the you're not going to find them by the software's wording of them.

6) Alot of doctors are old school and like the charting system. All of my practices have the capability of doing EMR through my software (at their own expense) but not one is interested.

7) Also the demographic info better be put in right. From the name to the DOB to the right sex. This is a MAJOR part of billing and the most often overlooked. If anything doesnt match what the pt has on file with the ins co (most ins co's) the claim will be rejected. This was a problem when I first started up my company as the demo info was sent over on a typed sheet by the dr's front office person. It wasnt long before I insisted that I get the handwritten pt demo and copies of the ins cards.

THis was a topic I spok about, around 6 years ago. As we progress electronically, the provider will have the capability to have the claim submited before the patient walks out of the office and the claim wil be paid and deposited before the patient leaves the parking lot. What technology will not do is eliminate coders and billlers. Coders wll still be needed to properly code the claim, unless the insurance companies develop claim software allowing the provider or coderr to code the claim in their system. Billers wil always be needed to get the claims paid properl, denials appealed and a providers A/R worked, Even if we have wonderful technology, as long as there is the human factor involved, some insurance companies, providers or pracices will never change to do things the right way, thereby keeing us in business. I remember when the word went around when people said computers will eliminate most jobs. Instead work incresed.